What is the ACL?
ACL stands for ‘Anterior Cruciate Ligament’, which is located in the center of the knee. It is one of four ligaments that provides knee stability, mobility and strength. A torn ACL causes the knee to buckle during activity, and is one of the most common knee injuries.
What causes an ACL tear
ACL tears occur often in high demand sports, like tennis and skiing, that require rapid changes in direction, sudden stopping, slowing while running, incorrect landing from jump, or direct collision or contact. This injury is also common in football, soccer and basketball. But most ACL injuries occur without contact or collision.
The tear may be partial or complete but most tears are complete tears. Female athletes suffer more ACL injuries than men. 50% of ACL injuries also damage other knee structures. And repeated instability can further damage the knee.
What are the symptoms of an ACL injury?
- A popping sound when the knee moves
- The knee gives out and the patient is unable to support themselves on the injured knee
- There is pain, swelling and tenderness
- Loss of full range of motion
- Difficulty walking, climbing, and standing
What is ACL reconstruction?
ACL reconstruction is a surgical procedure to rebuild the ligament to restore stability, strength and full function. If the patient has knee instability surgery may be needed to prevent damage to the meniscus.
When is this surgery recommended?
Reconstruction may be recommended when the patient has knee instability with normal activity, knee pain, injured ligaments, a torn meniscus, or when instability limits the patient’s activities, the ability to walk, or participation in desired sporting activities.
Additionally, each time the knee buckles it damages the cartilage and can lead to post-injury arthritis. Further, without surgery there is a risk of knee dislocation.
When an ALC is torn, it cannot repair itself, so whether to have surgery depends on each individual, the severity of the tear, and whether they can go about their day with compromised function.
Diagnosis of an ACL injury
Evaluation of the injury will begin with a history of the injury and symptoms. The SCOS orthopedic expert will conduct range of motion testing and will likely order x-rays and imaging tests to confirm the diagnosis.
Do all ACL injuries require surgery?
It depends. Some patients may have little to no instability and few symptoms. Each patient is unique and their level of activity, the degree of injury and instability will determine whether surgery is necessary or desired. Some may choose to avoid surgery initially by trying physical therapy. Often the patient will be sent for rehabilitation before surgery to restore range of motion and allow for swelling to reduce.
Conservative Treatment
A regimented rehab program to improve balance and coordination with knee strengthening exercises can, in some cases, restore the patient to near their pre-injury state, and delay or eliminate the need for surgery. All patients will require the use of a knee brace for support and stability. Studies report that 60% of those who delay surgery find that didn’t need it. However, when the injury involves damage to other knee structures, surgery will be recommended.
The key decision point is the patient’s level of activity, and the patient’s desire to return to sports and recreational activities. Professional athletes, even high school athletes who desire to get back in the game, will require surgery.
ACL Reconstruction Surgery
ACL reconstruction is a minimally invasive arthroscopic procedure accomplished with only a few small incisions. Recovery requires 6-9 months of rehab for complete return to function.
Surgical reconstruction requires removal of the ACL and replacement of the ligament with a tissue graft. The graft may be made of tissue harvested from the patient’s body, or from another person or donor. The choice of graft type is determined based on the patient’s age and lifestyle.
The long-term success rate for ACL reconstruction surgery is reported as 82-95%. But 8% of surgery patients suffer with recurrent instability and graft failure. However, surgery is not a guarantee that the ACL will fully heal, or not be subject to future injured.
At SCOS we have three outstanding fellowship trained, sports medicine knee specialists with specialized training in arthroscopic knee surgery and ligament replacement. They have the dedication and desire to help their patients return to an active lifestyle and return to play.
When you or a loved one suffers with a knee injury, you can depend on our specialists to provide you with compassionate, state-of-the-art care so you can return to the life you love.
